Case Study 13 (16.4)
This should not have been done on wordpad. There is no Running head, title pg, headers, pg numbers.   APA is part of your grade   12.5/15
1.	Hospice helps patients that are terminally ill to live their last days of life as alert and pain free as possible. Symptoms are managed to allow the individual live with their last days with dignity and quality. It does not post pone death but enhances life. Hospice care is used to treat the person and quality of life rather than the disease and the length of life. It encourages the family to be involved in the individuals care and decisions (Hospice, n.d.). This should have been American Cancer Society, 2012

2.	Jane or her family members may call a local hospice agency to request services. The hospice agency will then contact Jane’s physician for a referral to determine if hospice is appropriate for her. Jane may also speak directly with her physician, who may then make a referral for hospice care. Once a referral is made by a physician, hospice will then contact Jane to set up a meeting to review services that will be provided, make an assessment, and sign consent forms. Care will usually begin within a day or two of this process (Caring, n.d.).

3.	The hospice interdisciplinary team provides services such as helping the patient to be as comfortable as possible by managing the patient’s pain and symptoms. They also assist in emotional, psychosocial, and spiritual aspects of dying. They provide any supplies, equipment, and drugs that the patient may need for comfort. They may help coach the family on how to assist and care for the patient. If the patient needs it, they may assist with physical and speech therapy. If symptoms and pain are too difficult to manage in a home setting or the caregiver needs respite time the hospice team may provide short term inpatient care. They also provide counseling and bereavement care for the family and friends surviving the patient (Caring, n.d.).

4.	Over 90% of hospice agencies in the United States are covered by Medicare. A person’s health may improve over the course of hospice in which case the physician may no longer see hospice as necessary. If this happens it is the patient’s right to stop receiving hospice, or for any other reason. If the patient chooses to do so they will receive the Medicare coverage they had before starting hospice. If needed, they may go back to receiving hospice at any time. Medicare benefit eligibility requirements are if the patient is eligible for Medicare Part A, if the patient’s physician and hospice medical director certify the patient has a life-limiting illness and death is expected within six months, consent is signed accepting hospice in place of routine Medicare coverage, and care received from a Medicare approved hospice agency. Services provided under these benefits include doctor services, nursing care, medical equipment and supplies, pain relief and symptom control by drug therapy, short term care provided in a hospital setting if needed, home health care and homemaker services, physical, speech, and occupational therapy, social work service, dietary counseling, and grief support (Caring, n.d.).

5.	Other than pain physical symptoms that may be common in the end of life are fatigue, nausea, vomiting, constipation, delirium, and dyspnea (Alexander & Ross, 2001).
6.	The hospice nurse may reassure Jane that care will be provided to her 24 hours a day, 7 days a week to assist in making her as comfortable as possible. This includes treating her pain with any dugs that may be necessary to help make her comfortable.

7.	The nurse should encourage the family to be active and involved in Jane’s care and decision making. Also, hospice may be discontinued at any time if the patient does not feel it is necessary. If this happens, the patient may also then resume hospice care at any time. Hospice also encourages quality of life and dignity of the human being. It supports treating symptoms and not prolonging life or treating the disease. 

8.	Jane should be the one to make the decision on whether hospice should be received as long as she is fully capable of making decisions. If she is in a cognitive state to where she cannot make her own health decisions, a health care power of attorney should make this decision based on her wishes or according to her living will. It would be in Jane’s best interest to consult her family in making this decision and encourage her family to be involved in the decision making process. Having the support of her family is crucial in her care. 

References
All this should be double spaced
Alexander, C. S., & Ross, D. D. (2001, September 1). Management of common symptoms in terminally ill patients: Part I, fatigue, anorexia, cachexia, nausea, and vomiting. American Academy of Family Physicians. Retrieved from http://www.aafp.org/afp/2001/0901/p807.html 

Caring Connections. (n.d.). Retrieved from http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3356  this is not the correct name of the organization that wrote this

Hospice Care. (n.d.). Retrieved from http://www.cancer.org/Treatment/FindingandPayingforTreatment/ChoosingYourTreatmentTeam/HospiceCare/index
the author here is the American Cnacer Society. (2012).